Nutrition in the Management of Chronic Kidney Disease .

Many patients I have come across who have been diagonised with Chronic Kidney Disease often wonder what is the right food to eat and the food to avoid. It is always my responsibility to explain to them and assure them their condition is manageable through a renal diet that I design for them together .It is often an individual approach together with the caregiver.Nutrition is an integral part in management of renal problems ,starting from acute stages to advanced stages ; chronic kidney disease (CKD) and End Stage Renal Disease .(ESRD).

My responsibilities as a Nutritionist include the following :

  • Dietary counseling and meal planning
  • Management of Malnutrition and Anaemia that often are associated with the condition
  • Assessing Patient’s Nutrition status
  • Prescription of Nutrition supplies.

What is the Right diet?

Eating well when you have kidney disease is very important to help you stay as healthy and strong as possible.
Including the right kinds and amounts of foods each day recommended for healthy eating can help your kidneys to work more easily and keep you well for longer.
Sometimes having kidney disease can make you feel unwell. Your appetite may not be so good and food may taste different. This is because waste products produced from the foods you eat build up in the blood instead of being removed by the kidneys.
The need to make changes to your diet depends on how well your kidneys are working.
What is right for others may not be right for you.
What about protein and kidney disease?
Protein foods are essential to help keep your body healthy, repair body muscle and tissues and heal wounds.
Beef, lamb, chicken, fish, eggs, milk and dairy foods are all examples of protein foods. When you have kidney
disease, eating too much or too little protein can make you feel unwell.
Eating moderate portions of protein can help to reduce the work load of the kidneys and reduce high levels of waste products in your blood.
Choose palm sized portions of meats at meals. For a CKD patient on dialysis ,it is advisable to increase intake of protein rich foods especially from animal sources (of high biological value) to provide 1.1-1.5g/kg body weight .

Potassium in the diet .

Potassium restriction is required but the level of restriction is partly dependent on residual renal function. What I mean is that limitation of potassium rich food sources including fruits like bananas ,avocado ; vegetables like spinach ,potatoes ,beetroots ; drinks like fresh fruit juices ,milky drinks and drinking chocolate should be strict.

A Food scientist like me knows that potassium is water soluble and therefore they should advise their patients on suitable cooking methods including;

  • Using large volumes of water for boiling vegetables and discarding this cooking water.
  • Boiling potatoes
  • Parboiling vegetables before adding them to stews ,sauces and soups .
  • Avoiding use of pressure cookers and microwave cooking.

Phosphate is another vital mineral in management. So what about it?

Phosphate rich foods including milk ,dairy products ,chocolate ,egg(yolk) ,seafood , nuts should be restricted.

What of sodium?

Well as we all know salt and all salty foods are sources of sodium . only 5-6 g of sodium should be consumed. Reducing salt aims to control Blood pressure and reduces fluid weight gains especially between dialysis sessions .Studies support the fact that salt increased thirst and causes the body to retain fluid. Now you know !

Fluid intake .What is more and what is less?

Usually these patients are advised to restrict fluids to 500mls+ previous day’s urine output .

CKD Patient’s on dialysis generally have a difficulty in achieving recommended energy intake . They should therefore see a Nutritionist for advice aimed at increasing their energy intake or for prescription of energy supplements.

Nutrition Supplements often prescribed and why they are important.

Supplementation is often required if initial food remains insufficient to meet nutritional requirements. Examples include

  • Pentasure DLS – Balanced nutrition for dialysis care.
  • Renogold – Alpha Ketoanalogue and Essential Amino Satchet.

In CKD patients , kidneys often do not make enough Erythropoietin hormone which the body needs to make red blood cells .Therefore iron sucrose is given to prevent anaemia in the patient.

You can leave a comment or a question if you need any clarification .

From the Nutritionist Desk . Till next time , adios.

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